As Memories of Dalkon Shield Fade, Women Embrace IUDs Again

Imagine a world in which women trying to avoid unplanned pregnancies don’t have to worry about popping a daily pill that shoots their moods to hell, getting shots, buying condoms that sometimes break or changing a patch. Imagine a contraceptive method with which 99 percent of its users report satisfaction. Sound like a dream?

What’s more, it may prevent cervical cancer. Still more? According to a study in the New England Journal of Medicine, women using pills, patches, or rings “had a risk of contraceptive failure that was 20 times as high as the risk” among those using IUDs.” Not enough? They require no upkeep or attention. One doctor described the IUD as the “set and forget” method. And while cost may have initially been a problem (the devices cost between $500 and $1,000 up front, but birth control pills, at $50-100 a month, are less cost-effective in the long-term), the recently-enacted Affordable Care Act, which covers IUDs, alleviates that substantial financial burden.

It’s not surprising, then, that a recent national survey shows that a rapidly increasing number of U.S. women are using the devices as their birth control method of choice. But that number remains startlingly low: a mere 8.5 percent of women choose the temporary implant.

The A.H. Robins Company sold an estimated 2.5 million Dalkon Shields in the 1970s, when nearly 10 percent of women using birth control were relying on IUDs. The company advertised them as a highly effective, moderately-priced means of preventing pregnancy, and aggressively marketed the product to teenagers in college, the underprivileged and women of color as a “population control” method of sorts.

Brochures describing the Dalkon Shield as “Designed for Greater Comfort” were actually promoting a product that had an ill-designed removal string that wicked bacteria into the uterus, facilitating Pelvic Inflammatory Disease (PID) and sepsis (blood poisoning) which, when untreated, can cause infertility. Any problems with the device were touted as the fault of doctors inserting it rather than the faulty design, which A.H. Robins knew about when it purchased the rights to the product, yet chose to ignore. One physician wrote to Robins, saying:

I have found the procedure to be the most traumatic manipulation ever perpetrated on womanhood, and I have inserted thousands of other varieties.

It was pulled from the market just three years later in the U.S., but the damage was done. More than 300,000 lawsuits were filed against the A.H. Robins Company, with the largest settlement amounting to 2.2 million. As a result of the hefty settlement payments, A.H. Robins filed bankruptcy in 1985.

Though it’s been nearly 40 years since the Dalkon Shield was distributed, its formidable reputation lives on: Today, 30 percent of health providers are still unconvinced that IUDs are safe for women who have never given birth, though the newest devices have proven to be so and are endorsed by the American College of Obstetricians and Gynecologists.

The new and improved IUDs are like iPhones compared to the telegrams of old. Two brands are available in the U.S., ParaGard and Mirena. The Mirena IUD, made of flexible plastic, lasts for up to five years and releases small amounts of the hormone progestin into the bloodstream. The ParaGard IUD, which contains copper, doesn’t use artificial hormones and lasts up to 12 years; it can be removed at any time by your gynecologist.

Both the ParaGard and Mirena affect the way sperm move, thus hindering it from fertilizing the egg. The copper in the ParaGard IUD is toxic to sperm, while progestin released from the Mirena IUD may also thicken the uterine mucus to further block the sperm.

The IUD isn’t perfect by any means: It still carries an elevated risk of PID compared to other contraceptive methods, but women who use no contraception at all have a higher risk of infection than women with an IUD. Also, insertion can be quite painful and the device does not protect from sexually transmitted infections, so sex outside of a monogamous relationship still demands a condom.

U.S. women are behind [PDF] the rest of the world in IUD usage: Thirty-five percent of Vietnamese and Egyptian women, 30 percent of Chinese women and nearly 20 percent of Scandinavian women use them. Only in sub-Saharan Africa is their a lower usage rate than in the U.S. But the last decade has seen a rise in IUD usage in America, increasing from 2.4 percent in 2004 to 5.6 percent in 2008. And doctors predict that, given the new safety measures and revamped design, use of IUDs will continue to increase.

Maybe it’s time to celebrate innovations in safe and effective birth control and give IUDs another chance.

Comments

As a married, forty-six-year-old mom, stepmom, and grandmother, the last thing I want is to get pregnant! The next-to-last thing I want is to add any hormones to my already hormone-crazed body, so I am definitely going back to the IUD. It’s a no-brainer for me.

The IUD earned its reputation, and it isn’t just the Dalkon shield that had or has issues. The Ms. article didn’t mention the IUD’s risk of uterine and fallopian scarring (affected my family!) and uterine perforation. That doesn’t mean the only alternatives are hormonal contraceptives. Push combined barrier methods (diaphragm or cervical cap with spermicide, used with a condom) which provide contraception AND prevent infections like HIV and HPV, Ms.! Plus they’re easy to use, non-invasive and cheap!

If you aren’t at risk for STDs (monogamous with an STD free, monogamous partner) who wants to use condoms and spermacide forever? I had to use condoms for a week after I got my IUD replaced and it made me so thankful I don’t have to use them all the time. They are NOT cheap compared to an iud – especially if you have insurance partially or completely covering the iud!

Every single form of contraception has risks, not the least of which is failure. The risk of infection with IUD insertion under sterile technique is approximately 1 in 200 insertions; the risk of perforation is 1 in 2000. The risk of pregnancy with diaphragm use for parous women is approximately 20% with typical use. Cervical caps cannot be fitted to many parous women. Spermicide raises the risk of HIV transmission. By contrast, the IUD is low-risk, extremely effective, and not associated with an increased risk of infertility.

Would you rather more women used less-effective contraception, given the known risks of pregnancy, and given the current political climate? I love IUDs and have more and more patients choosing them.

Planned Parenthood’s birth control effectiveness comparison page lists the effectiveness of the diaphragm as 6% for consistent, correct use and 12% for not using the diaphragm as directed. Combining diaphragm use with condom use increases their effectiveness.

Meghan, would you please cite your statistical source for the diaphragm failure rate for parous women? Is that statistic for parous women who have not had their diaphragm re-sized after pregnancy or abortion, or who have given birth within 6 weeks? Is it for consistent and correct use?

Women have the right to choose which contraceptive is best for them, and they should be given information about the risks of IUDs in a Ms. IUD advocacy article. I would promote giving readers a full range of alternatives available through their health care provider to help them find the contraceptive method that is right for them. I’m happy to see that a Ms. blogger advocated for use of the diaphragm in “Where’d the Diaphragm Disappear To?” in 2010.

The Dalcon Shield was marketed as a safe and effective device. I do believe the evidence proves otherwise. Women should be provided with accurate medical advice. Absent scientific data, as in accurate and complete scientific data, should be used as a guide to make informed decisions.

what they dont tell you is that the risk to develop cysts is very high, i had to have a surgery half a year after the IUD insertion and was almost left sterilised. also the insertion is incredibly painful for women who have never bared a child – i was in bed for over a week afterwards not able to move because of the pain.

IUDs are also used for non-birth control reasons. I had one inserted under anathesia while undergoing a D&C for complications related to taking tamoxifen. Having one reduces my risk of building up menses and hemorraging once again. Hurray!

I’ve had the Mirena for 2 years and I couldn’t recommend it more. No worries and no periods. Yay! It was painful having it put in and I fainted about half an hour later, but since then it has given me no problems. i’d recommend it to anyone. I can’t believe I put up with periods for so long when there was such an easy way out.

Since when does fainting involve an easy way out. Menstrual cycles are meant to clean us out keep our hormones levels regulated. I’ve been on B.C since the 16 which included the noraplant and the nuva ring. At 36 I’ve been using the nuva ring on and off for the past two years my periods have been shifting monthly since I stopped altogether 6 months ago. My moods swings are PMMSD changes in sleep pattern a week or so before I guess I’m suppose to come on. I’m hoping I regulate out normally. Until then I’m through with B. C

Had one inserted (uncomfortable as my cervix is not easy to reach, points backwards) and was delighted at improved emotional well-being (no hormones to bloat me or make me depressed) and reduced spottiness of skin. Sadly, I felt the strings had moved, and one day it came out completely. Would like to trust it but I was one of the unlucky ones: still prefer it to all other pills etc. I`d say give it a go, but do get it checked if you think it`s moved.

I used an IUD from my mid-thirties, after I bore my fourth child, (2 of whom were conceived IN SPITE OF the use of a diaphram), until I was in my late sixties, when I was SURE I couldn’t become pregnant.
It is not new, just fell into disrepute because of one bad version. I never had a day of trouble. Far better than using condoms, which my husband and I both hated, and which were extremely unreliable. The “mood” could be spontaneous, with no interruption for birth-control appliances. Remember, there were no pills or patches available back then. And anyway, I agree with Debi: I also would not want to add more hormones to my body!

Hi, can anyone please help me with some questions I have…I was in a class action lawsuit againt dalkon shield I moved and lost touch with the lawfirm which I found out no longer exists…need to know who to contact if there is a trust set up to pay people with money that was awarded and never recieved…I want to thank anyone in advance that can help me…please email me rhondadunn51@yahoo.com

Stand up. Join me in encouraging the Washington Post to piblish an article about this tragedy against women. They knew and they marketed. History must be told so it is not repeated. The family lost nothing. Women lost much more. All in the name of the bottom line.

If the story of the Dalkon Shield were told again today, with all the twists and turns, would you still allow a foreign object to be inserted? It was marketed by an extremely reputable company. They sold Chapstick. Now if you cannot trust a 3 generation company, who knowingly marketed a faulty device that killed and sterilized women. We will never know how many, as so many were marketed to third world countries, who have no legal standing in the US. How can we be confident that the next revered company will not do the same?

Women in China are forced to have IUDs after their first child so I wouldn’t be using that fact as some kind of endorsement.
Also the lawsuits have already started against the Mirena, mainly for perforating the uterus.

Please do not try to lull women into believing that any foreign body introduced into the uterus or fallopian tubes is safe and effective. NO! t is not time to give such devices a so-called second-chance! At whose expense might I ask? Try looking at the nightmarish stories of over 2300 women in the Facebook group Essure problems. They trusted their doctors who glorified Essure, a birth control procedure that inserts metal coils containing nickel, PET fibers and other dangerous components into the fallopian tubes. These devices are causing just as much pain and suffering as the Dalkon Shield did with perforation, infection, autoimmune diseases and a host of other medical complications. Hundreds of these women have already undergone hysterectomies to remove these unsafe coils from their bodies and hundreds more are seeking surgery to try to regain their former health. To make matters worse, Essure was given pre-market approval by the FDA in 2002 after limited flawed studies on a “handful” of women. This status protects the manufacturerof Essure from lawsuits. So, while women injured by the Dalkon shield were at least able to receive much-deserved financial retribution for their suffering, women harmed by Essure have NO legal recourse. Birth control is not a life-saving device and foreign bodies should never be put in anybodies organs for that purpose!